The clinical efficacy of Ruscus Aesculatus extract: is there enough evidence to update the pharmacotherapy guidelines for chronic venous disease?

The wide range of clinical presentations and patient complaints related to chronic venous disease often require complex treatments based on lifestyle modification, the use of compression stockings, pharmacotherapy, and/or surgical or other minimally invasive treatments.

According to most available guidelines, the main indication for pharmacotherapy in patients with chronic venous disease is the presence of symptoms related to venous hypertension, including leg pain and heaviness. Additional patient complaints that are indicators for venotrophic pharmacological treatment include leg edema and venous leg ulcers. Despite these suggested indications, the clinical evidence for the benefit of many available drugs remains questionable. The paper presents an overview of the available literature on Ruscus aculeatus extract and drugs containing Ruscus extract. The current literature and a recent systematic review and meta-analysis confirm the use of Ruscus aculeatus extract as a phlebotropic drug with evidence-based confirmation of its positive effects on complaints related to chronic venous disease. The variety of possibilities for the pharmacological treatment of chronic venous disease enables pharmacological intervention using various compounds that address different mechanisms of chronic venous disease-related pathology. The current evidence concerning Ruscus aculeatus as a component of combined treatment (with hesperidin methyl chalcone and ascorbic acid) suggests the need to upgrade the position of this drug in the current CVD pharmacotherapy guidelines.